Angiography, visceral, selective or supraselective (with or without flush aortogram), radiological supervision and interpretation

Transcription

1 Reimbursement Guidelines Coding and Reimbursement Guidelines for Oncology Therapy Products This is general reimbursement information only; it is not legal advice, nor is it advice about how to code, complete or submit any particular claim for payment, nor intended to increase or maximize reimbursement by any third party payer. This information was correct at the time of publication; however, it is always the responsibility of the provider to determine appropriate coding and charges for insurance claims. All coding and reimbursement information is subject to change without notice. Payers or their local branches may have their own coding and reimbursement requirements and policies. Before filing any claims, providers should verify the payer s current requirements and policies. CPT codes copyright 2010 American Medical Association. All Rights Reserved. CPT is a trademark of the AMA. o fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/ [DFARS restrictions apply to Government Use. [ There are no C-Codes for AngioDynamics oncology products.

2 Liver-Embolization Hepatic Angiogram $ (Global) $58.46 (Prof) $ (Tech) Angiography, visceral, selective or supraselective (with or without flush aortogram), radiological supervision and interpretation 0279 (Q2)* $1,962.36* $ (Global) $18.40 (Prof) $ (Tech) Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation (List separately in addition to code for primary procedure) Access Celiac Trunk $ Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within vascular family $ initial second order abdominal $ initial third order $54.49 additional second order, third order, and beyond (List in addition to code for initial second or third order vessel as appropriate) Embolization Procedures $ Transcatheter occlusion or embolization (eg, for tumor destruction, to achieve hemostasis, to occlude a vascular malformation), percutaneous, any method, non-central nervous system, non-head or neck 0082 (T) $6,290.62* $68.56 Transcatheter therapy, embolization, any method, radiological supervision and interpretation $87.32 Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion 0261 (Q1)* $75.23* *Please note that these services are OT payable in the ASC setting. MS-DRG 435 Malignancy of hepatobiliary system or pancreas with MCC $9, Malignancy of hepatobiliary system or pancreas with CC $6, Malignancy of hepatobiliary system or pancreas without CC/MCC $4, Chemotherapy without acute leukemia as secondary diagnosis with MCC $11, Chemotherapy without acute leukemia as secondary diagnosis with CC $4, Chemotherapy without acute leukemia as secondary diagnosis without CC/MCC $4,301 ICD-9 Code (Diagnosis Codes) V58.11 Encounter for antineoplastic chemotherapy Malignant neoplasm of liver, primary Malignant neoplasm of liver, not specified as primary or secondary Secondary malignant neoplasm of liver, specified as secondary ICD-9 Code (Procedure Codes) 435 Injection or infusion of cancer chemotherapeutic substance 436 Arterial catheterization 437 Arteriography of other intra-abdominal arteries *Hospital payment for codes with a Q status indicator will be packaged (not separately paid) if the code is reported with any other services that are separately payable under the on the same date of service (status indicator S, T, V or X if Q1 or status indicator T if Q2).

3 Liver-RFA $1, $ $ $ $ Laparoscopy, surgical, ablation of one or more liver tumor(s); radiofrequency Ablation, one or more liver tumor(s), percutaneous, radiofrequency Imaging Guidance Ultrasound Open Liver Procedures (Medicare inpatient only procedures) ASC 0174 (T) $7, ot Covered () $3, $2, () () () /A /A /A $1, Ablation, open, of one or more liver tumor(s); radiofrequency (C) ot Covered ot Covered MS-DRG 405 Pancreas, liver and shunt procedures with MCC $29, Pancreas, liver and shunt procedures with CC $13, Pancreas, liver and shunt procedures without CC/MCC $9,437 ICD-9 Code (Diagnosis Codes) Malignant neoplasm of liver, primary Malignant neoplasms intrahepatic bile ducts Malignant neoplasm of liver, not specified as primary or secondary Secondary malignant neoplasm of liver, specified as secondary Benign neoplasm of liver and biliary passages Carcinoma in situ of liver and biliary system eoplasm of uncertain behavior of liver and biliary passages eoplasm of unspecified nature of digestive system 570 Acute and subacute necrosis of liver ICD-9 Code (Procedure Codes) Open ablation of liver lesion or tissue Percutaneous ablation of liver lesion or tissue Laparoscopic ablation of liver lesion or tissue Reimbursement Terminology APC: Ambulatory Classification ASC (G2): on office-based surgical procedure added in CY 2008 or later; payment based on relative payment weight APC (C): Inpatient Only Procedure; procedure is not covered by CPT Current Procedural Terminology Medicare in outpatient settings APC (): Paid under ; payment is packaged into payment for other service C-Code: Device category codes reported by hospitals in conjunction with outpatient hospital procedures

4 Other Soft Tissue-RFA $ $ $ RF Procedures on-facility $2, Carrier Determined Ablation therapy for reduction or eradication of one or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, radiofrequency, unilateral Ablation therapy for reduction or eradication of one or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, radiofrequency, unilateral ASC 0423 (T) $3, $2, /A /A /A /A /A /A /A /A Carrier Determined /A /A /A MS-DRG 166 Other respiratory O.R. procedures with MCC $19, Other respiratory O.R. procedures with CC $10, Other respiratory O.R. procedures without CC/MCC $6,803 ICD-9 Code (Diagnosis Codes) Malignant neoplasm of main bronchus Malignant neoplasm of upper lobe, bronchus, or lung Malignant neoplasm of middle lobe, bronchus, or lung Malignant neoplasm of lower lobe, bronchus, or lung Malignant neoplasm of other parts of bronchus or lung Malignant neoplasm of bronchus and lung, unspecified site Malignant neoplasm of parietal pleura Malignant neoplasm of visceral pleura Malignant neoplasm of other specified sites of pleura Malignant neoplasm of pleura, unspecified site ICD-9 Code (Procedure Codes) Percutaneous ablation of lung lesion or tissue APC (Q1): Paid under ; packaged APC payment if billed on same date of service as a HCPCS code with status indicator of S, T, V, or X ; ICD-9-CM International Classification of Diseases, 9th Revision, Clinical Modification APC (Q2): Paid under ; packaged APC payment if billed on same date of service as a HCPCS code with status indicator of T MS-DRG Medicare-severity Diagnosis Related Group

5 Other Soft Tissue-RFA $ $ $ $ RF Procedures on-facility $3, Carrier Determined Carrier Determined Carrier Determined Laparoscopic Procedures ( Facility setting only) Ablation, one or more renal tumor(s), percutaneous, unilateral, radiofrequency Ultrasound guidance for, and monitoring of, parenchymal tissue ablation Ablation, one or more renal tumor(s), percutaneous, unilateral, radiofrequency Ultrasound guidance for, and monitoring of, parenchymal tissue ablation ASC 0423(T) $3, $2, /A /A /A /A /A $2, /A /A /A /A /A /A $ Laparoscopy, surgical, ablation of renal cysts 0130 (T) $2, ot Covered $1, Laparoscopy, surgical, ablation of renal mass lesion(s) 0174 (T) $7,409.52c ot Covered MS-DRG 656 Kidney and ureter procedures for neoplasms with MCC $17, Kidney and ureter procedures for neoplasms with CC $9, Kidney and ureter procedures for neoplasms without CC/MCC $7,138 ICD-9 Code (Diagnosis Codes) Malignant neoplasm of kidney, except pelvis Malignant neoplasm of renal pelvis Malignant neoplasm of other specified sites of urinary organs Malignant neoplasm of urinary organ, site unspecified Secondary malignant neoplasm of kidney ICD-9 Code (Procedure Codes) Open Ablation for renal lesion or tissue Percutaneous ablation of renal lesion or tissue Laparoscopic ablation of renal lesion or tissue APC (S): Medicare APC payments are reimbursed at 100% for secondary procedures with a status indicator of S Facility Physician payment level for professional services provided in a facility setting such as a hospital or ambulatory surgery center APC (T): Medicare APC payments are reimbursed at 50% for secondary procedures with a status indicator of T on- Facility Physician payment level for professional services provided in a non-facility setting such as a physician s office ASC: Ambulatory Surgery Center : Outpatient Prospective System

6 Bone-RFA ASC $ RF Procedures on-facility $3, Ablation, bone tumor(s) (eg, osteoid osteoma, metastasis) radiofrequency, percutaneous, including computed tomographic guidance Ablation, bone tumor(s) (eg, osteoid osteoma, metastasis) radiofrequency, percutaneous, including computed tomographic guidance 0051 (T) $3, $1, /A /A /A MS-DRG 495 Local excision and removal int fix devices exc hip and femur with MCC $15, Local excision and removal int fix devices exc hip and femur with CC $8, Local excision and removal int fix devices exc hip and femur without CC/MCC $5,402 ICD-9 Code (Diagnosis Codes) Malignant neoplasm of bones of skull and face, mandible Malignant neoplasm of mandible Malignant neoplasm of vertebral column, excluding sacrum and coccyx Malignant neoplasm of ribs, sternum, and clavicle Malignant neoplasm of scapula and long bones of upper limb Malignant neoplasm of short bones of upper limb Malignant neoplasm of pelvic bones, sacrum and coccyx Malignant neoplasm of long bones of lower limb Malignant neoplasm of short bones of lower limb Malignant neoplasm of bone and articular cartilage, site unspecified When Bone Cancer is Secondary to Another Malignancy Secondary malignant neoplasm bone and bone marrow ICD-9 Code (Diagnosis Codes) 01.6 Excision of lesion of skull 76.2 Local excision or destruction of lesion of facial bone Local excision of lesion or tissue of bone USA > 603 Queensbury Avenue, Queensbury, Y > tel: or > fax: International > Building 2000, Beach Drive, IQ Cambridge, Waterbeach, Cambridge, CB25 9TE > United Kingdom tel: > fax: AngioDynamics is a registered trademark of AngioDynamics, Inc AngioDynamics, Inc. MLC 388 US Rev A